Six health care providers plead guilty to cheating Medicaid

Raleigh: Six health care providers have pleaded guilty in the past month for ripping off taxpayers and the Medicaid system, including four guilty pleas this week, Attorney General Roy Cooper announced Wednesday.

The cases were investigated and prosecuted by Cooper’s Medicaid Investigations Division, which is made up of attorneys, financial investigators and State Bureau of Investigation agents.

“We’re cracking down on Medicaid fraud because it wastes taxpayers’ money, squanders funds that should go to needed care, and drives up health care costs for all of us,” Cooper said.

Bobby Faison of Henderson pleaded guilty on Monday to one felony count of medical provider fraud and one felony count of offering or paying kickbacks by a Medicaid provider for billing for child behavioral health services that were not provided.

Wake County District Court Judge Vince Rozier sentenced Faison on Monday to 24 months of supervised probation and ordered him to repay $56,179.68 to the Medicaid program. Faison also faces 50 hours of community service and is banned while on probation from being employed in any job that could result in billing Medicaid. If he violates the terms of his probation, Faison could face six to eight months behind bars.

Cooper’s Medicaid Investigations Division (MID) began investigating Faison, a counselor with Prodigious Health Services in Vance County, in December 2011 following a call from a Medicaid recipient. The caller said that Prodigious had billed North Carolina Medicaid using her family’s Medicaid recipient numbers even though no one in her family had ever received any medical services from Prodigious. MID investigators uncovered a system of kickbacks and billing for services not actually provided, including paying people $25 for each Medicaid recipient referral and offering incentives, such as payment of utility bills and toys for their children, for people to provide their family’s Medicaid recipient numbers.

Also this week, Tammy Atkins, Deborah Aroche, and Amy Lyall pleaded guilty on Tuesday in Alleghany County court for submitting false timesheets for personal care services they did not actually provide while working for Families First Home Health Care.

Atkins pleaded guilty to two counts of misdemeanor attempted Medicaid fraud and was sentenced to 90 days in jail suspended for 36 months of supervised probation. She must pay $3,997.68 in restitution and fees and perform community service.

Aroche pleaded guilty to one count of misdemeanor attempted Medicaid fraud and was sentenced to 45 days in jail suspended for 60 months supervised probation. She must pay $8.018.10 in restitution and fees.

Lyall pleaded guilty to one count of misdemeanor attempted Medicaid fraud and was sentenced to 120 days in jail suspended for 36 months supervised probation. She must pay $3,667.44 in restitution and fees and perform community service.

A fourth employee of Families First Home Health Care, Jessica Cook, pleaded guilty February 26 to two counts of misdemeanor attempted Medicaid fraud. She was sentenced to 45 days in jail suspended for 24 months of supervised probation plus community service and ordered to pay $3,020.36 in restitution, court costs and fees. Charges are pending against a fifth employee, Michelle Bottomley.

The owner of Families First Home Health Care, Betty Ann Cook, pleaded guilty last year to related federal charges for running the fraud scheme. That case was investigated and prosecuted by the US Attorney’s Office and the US Department of Health and Human Services Inspector General along with Cooper’s MID.

Cook, Lyall, Aroche and Atkins were arrested in December 2012 as part of a statewide sweep that netted nine arrests. Another defendant arrested as part of that sweep, Kellie Hickman, pleaded guilty earlier this month for submitting falsified timesheets for home health care work while employed by United Home Care, Inc. On March 7, Hickman pleaded guilty in Sampson County court to two misdemeanor counts of attempted medical assistance provider fraud. She was sentenced to 45 days in jail suspended for 12 months of supervised probation plus community service and ordered to pay $3,524.90 in restitution, court costs and fees.

“With more investigators and attorneys on the job, we’re finding more fraud and making wrongdoers pay,” Cooper said. “Guilty pleas and money recovered save taxpayer money and discourage health care providers from cheating.”

In another recent case, the MID recovered $1,083,619.28 last month for the state’s Medicaid program from Healthpoint, Ltd. and its partner, DFB Pharmaceuticals. The drug companies caused false claims to be submitted to the North Carolina Medicaid program for an unapproved drug, Xenaderm. North Carolina’s settlement is part of $33 million the companies paid to settle Medicaid fraud claims nationally.

North Carolina’s MID has recouped more than $500 million over the past decade and helped to convict hundreds of individuals on criminal charges including patient abuse and neglect as well as financial fraud. During the federal fiscal year that ended September 30, 2012, the MID won 33 criminal convictions and 14 civil settlements that recovered $94,390,397.85 from Medicaid abusers.

The MID investigates fraud and abuse of Medicaid benefits by hospitals, doctors, pharmaceutical companies, medical equipment companies, mental health and personal care providers, ambulance services and others. The division also investigates patient abuse and neglect in nursing homes and other facilities that receive Medicaid funds. The unit works closely with United States Attorneys, District Attorneys, and other state and federal law enforcement agencies.

Assistant Attorney General John Parris prosecuted and Financial Investigator Richard Bedford investigated the Faison case with assistance from the SBI and the NC Division of Medical Assistance, Program Integrity Section. Parris prosecuted and Financial Investigator Douglas Crawley investigated the Hickman case with assistance from the Sampson County District Attorney’s Office. Assistant Attorney General Laura Lansford prosecuted and SBI Special Agent Emily Foss investigated the Atkins, Aroche, Lyall and Cook cases with assistance from local law enforcement, the US DHHS Inspector General, and the Internal Revenue Service.